Provider Demographics
NPI:1063602415
Name:MEADEN, PETER JOHN (LAC, DIPL OM)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JOHN
Last Name:MEADEN
Suffix:
Gender:M
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 CAMINO DEL RIO S STE 220
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3715
Mailing Address - Country:US
Mailing Address - Phone:619-993-6897
Mailing Address - Fax:
Practice Address - Street 1:2515 CAMINO DEL RIO S STE 220
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3715
Practice Address - Country:US
Practice Address - Phone:619-993-6897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11292171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist